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Sar-Pomian M, Starace MV, Lencastre A, Piraccini BM, Richert B, Rudnicka L, Trakatelli MG, Iorizzo M. Dermoscopic Nail Changes in Psoriasis, Lichen Planus, and Lichen Striatus. Skin Appendage Disord 2024; 10:273-292. [PMID: 39021761 PMCID: PMC11250660 DOI: 10.1159/000538581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/20/2024] [Indexed: 07/20/2024] Open
Abstract
Background Onychoscopy is a noninvasive method helpful in diagnosing nail disorders. The aim of the study was to review literature on the usability of onychoscopy in nail psoriasis, nail lichen planus, and nail lichen striatus. Summary Onychoscopic features of nail psoriasis are pitting, onycholysis with erythematous border, salmon patches, splinter hemorrhages, dotted vessels in lateral and proximal folds, and hyponychium. Onychoscopic features of nail lichen planus are onychorrhexis, onycholysis, longitudinal melanonychia, and red lunula. The literature on the usability of onychoscopy in nail lichen striatus is scarce. Keynotes Onychoscopy facilitates evaluation of nail abnormalities compared to the clinical examination. Lunular alterations, salmon patches, erythematous border of onycholysis as well as splinter hemorrhages in nail psoriasis are better visualized with onychoscopy compared to the naked eye. Onychoscopy enhances detection of melanonychia, dyschromia, and lunular changes in nail lichen planus. Onychoscopic features are different in fingernails and toenails.
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Affiliation(s)
- Marta Sar-Pomian
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Michela V.R. Starace
- Dermatology Unit, IRCCS Azienda Ospendaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrè Lencastre
- Unidade de Dermatologia, Hospital de Cascais Dr. José de Almeida, Lisbon, Portugal
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospendaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Bertrand Richert
- Dermatology Department, Université Libre de Bruxelles, University Hospital Brugmann and Saint-Pierre, Brussels, Belgium
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Matilde Iorizzo
- Private Dermatology Practice, Lugano/Bellinzona, Switzerland
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Tekin B, Xie F, Lehman JS. Lichen Planus: What is New in Diagnosis and Treatment? Am J Clin Dermatol 2024:10.1007/s40257-024-00878-9. [PMID: 38982032 DOI: 10.1007/s40257-024-00878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/11/2024]
Abstract
Lichen planus (LP), an idiopathic, multifaceted chronic inflammatory disease with a heterogeneous clinical presentation, affects approximately 0.5-1% of the population. The various clinical manifestations of LP fall into three broad categories, namely cutaneous, appendageal, and mucosal, with further subclassification depending on the morphology and distribution patterns of individual lesions. There is mounting evidence that LP has systemic associations, including autoimmune conditions, glucose intolerance, dyslipidemia, and cardiovascular disorders. Cutaneous hypertrophic and mucosal forms of LP are at a heightened risk for malignant transformation. Familiarity with these potential associations in conjunction with long-term follow-up and regular screening could lead to a timely diagnosis and management of concomitant conditions. In addition, the frequent quality of life (QoL) impairment in LP underscores the need for a comprehensive approach including psychological evaluation and support. Several treatment strategies have been attempted, though most of them have not been adopted in clinical practice because of suboptimal benefit-to-risk ratios or lack of evidence. More recent studies toward pathogenesis-driven treatments have identified Janus kinase inhibitors such as tofacitinib, phosphodiesterase-4 inhibitors such as apremilast, and biologics targeting the interleukin-23/interleukin-17 pathway as novel therapeutic options, resulting in a dramatic change of the treatment landscape of LP. This contemporary review focuses on the diagnosis and management of LP, and places emphasis on more recently described targeted treatment options.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Dermatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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Arnal C, Richert B. Nail disorders to be kept in mind. HAND SURGERY & REHABILITATION 2024; 43S:101640. [PMID: 38215878 DOI: 10.1016/j.hansur.2024.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024]
Abstract
Recognizing and diagnosing the most common nail diseases is essential, to be able to guide patients and provide appropriate treatment. However, uncommon nail disorders should not be neglected, in order to avoid inadequate treatment and above all to ensure that no severe underlying disorder, with severe prognosis, is overlooked.
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Affiliation(s)
- Charlotte Arnal
- Dermatology Department, Université Libre de Bruxelles, University Hospital Brugmann - Saint-Pierre - Children Hospital Queen Fabiola, Brussels, Belgium.
| | - Bertrand Richert
- Dermatology Department, Université Libre de Bruxelles, University Hospital Brugmann - Saint-Pierre - Children Hospital Queen Fabiola, Brussels, Belgium.
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Hwang JK, Grover C, Iorizzo M, Lebwohl MG, Piraccini BM, Rigopoulos DG, Lipner SR. Nail psoriasis and nail lichen planus: Updates on diagnosis and management. J Am Acad Dermatol 2024; 90:585-596. [PMID: 38007038 DOI: 10.1016/j.jaad.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Inflammatory diseases of the nail, including nail psoriasis and nail lichen planus, are associated with significant disease burden and have a negative impact on quality of life. Diagnosis is often delayed, especially when patients present without cutaneous findings. Therefore, recognizing clinical signs and symptoms of inflammatory nail diseases, and initiating timely and appropriate treatment, is of utmost importance. OBJECTIVE We review recent studies on diagnostic techniques, discuss severity grading and scoring systems, and describe consensus treatment recommendations for nail psoriasis and nail lichen planus. METHODS An updated literature review was performed using the PubMed database on studies assessing diagnostic techniques or treatment modalities for nail psoriasis and nail lichen planus. RESULTS Recent studies on diagnostic techniques for inflammatory nail disease have focused on use of dermoscopy, capillaroscopy, and ultrasound modalities. Treatment of these conditions is dichotomized into involvement of few (≤3) or many (>3) nails. Recent psoriatic therapeutics studied for nail outcomes include brodalumab, tildrakizumab, risankizumab, deucravacitinib, and bimekizumab, while emerging treatments for nail lichen planus include JAK inhibitors and intralesional platelet rich plasma injections. CONCLUSIONS We emphasize the need for increased awareness and expanded management strategies for inflammatory nail diseases to improve patient outcomes.
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Affiliation(s)
- Jonathan K Hwang
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Chander Grover
- Department of Dermatology, University College of Medical Sciences, New Delhi, India
| | | | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bianca M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Dimitris G Rigopoulos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
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Huang J, Shi W. Successful treatment of nail lichen planus with tofacitinib: a case report and review of the literature. Front Med (Lausanne) 2023; 10:1301123. [PMID: 38034544 PMCID: PMC10687541 DOI: 10.3389/fmed.2023.1301123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Nail lichen planus (NLP) is a chronic inflammatory disease of unknown etiology and has been recognized as a nail potentially critical disorder, which can be severe and rapidly worsen with irreversible scarring. Currently, the treatment options are limited based on disease progression. High-potency topical or intralesional corticosteroids are commonly considered first-line therapeutic options; however, these therapies are unsuitable for all patients with NLP, especially those with extensive lesions. As a potential therapeutic target for inflammatory skin diseases, Janus kinase (JAK) inhibitors can suppress both type-1 and type-2 cytokines, thereby reducing the immune response and resultant inflammation. Recent studies have suggested benefit in cutaneous lichen planus and lichen planopilaris with oral JAK inhibitors. Here, we report a case of severe NLP that exhibited a favorable response to tofacitinib treatment. A 41-year-old woman presented to our clinic with a 2-year history of nail dystrophy of all fingers of both hands. The NLP was finally confirmed by histopathology and the above clinical features. After the informed consent signature, tofacitinib monotherapy, 5 mg twice a day, was then begun, and after 6 months, the appearance of her nails had a significant improvement.
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Affiliation(s)
| | - Wei Shi
- Hu Nan Key Laboratory of Aging Biology, Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
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Fardos M, Dazé R, Hogan D. Isolated case of acquired onychodystrophy. JAAD Case Rep 2022; 32:59-62. [PMID: 36654770 PMCID: PMC9841359 DOI: 10.1016/j.jdcr.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mohammad Fardos
- Department of Dermatology, HCA Healthcare/USF Morsani College of Medicine GME: Largo Medical Center, Largo, Florida
| | - Robert Dazé
- Department of Dermatology, HCA Healthcare/USF Morsani College of Medicine GME: Largo Medical Center, Largo, Florida,Correspondence to: Robert Dazé, DO, Department of Dermatology, 350 Monon Blvd #251, Carmel, IN 46032.
| | - Daniel Hogan
- Department of Dermatology, Morsani College of Medicine University of South Florida/Bay Pines VA Healthcare System, Bay Pines, Florida
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